OBJECTIVE: To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock. DESIGN: Prospective, double-blind, randomized, placebo-controlled study. SETTING:Intensive care units of a university hospital. PATIENTS AND PARTICIPANTS: 30 adult patients with septic shock. INTERVENTIONS: Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h. MEASUREMENTS AND RESULTS: As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H2O2) by neutrophils (-33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H2O2 production. CONCLUSIONS: In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.
RCT Entities:
OBJECTIVE: To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock. DESIGN: Prospective, double-blind, randomized, placebo-controlled study. SETTING: Intensive care units of a university hospital. PATIENTS AND PARTICIPANTS: 30 adult patients with septic shock. INTERVENTIONS:Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h. MEASUREMENTS AND RESULTS: As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H2O2) by neutrophils (-33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H2O2 production. CONCLUSIONS: In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.
Authors: Didier Keh; Thomas Boehnke; Steffen Weber-Cartens; Christina Schulz; Olaf Ahlers; Sven Bercker; Hans-Dieter Volk; Wolf-Dietrich Doecke; Konrad J Falke; Herwig Gerlach Journal: Am J Respir Crit Care Med Date: 2002-11-08 Impact factor: 21.405
Authors: Axel R Heller; Susanne C Heller; Annette Borkenstein; Sebastian N Stehr; Thea Koch Journal: Intensive Care Med Date: 2003-07-17 Impact factor: 17.440
Authors: Karim Asehnoune; Pierre Joachim Mahe; Philippe Seguin; Samir Jaber; Boris Jung; Christophe Guitton; Nolwen Chatel-Josse; Aurelie Subileau; Anne Charlotte Tellier; Françoise Masson; Benoit Renard; Yannick Malledant; Corinne Lejus; Christelle Volteau; Véronique Sébille; Antoine Roquilly Journal: Intensive Care Med Date: 2012-07-10 Impact factor: 17.440
Authors: Caitlin W Hicks; Daniel A Sweeney; Robert L Danner; Peter Q Eichacker; Anthony F Suffredini; Jing Feng; Junfeng Sun; Brad Moriyama; Robert Wesley; Ellen N Behrend; Steven B Solomon; Charles Natanson Journal: Intensive Care Med Date: 2012-10-31 Impact factor: 17.440
Authors: Hilde H F Remmelts; Sabine C A Meijvis; Douwe H Biesma; Heleen van Velzen-Blad; G Paul Voorn; Jan C Grutters; Willem Jan W Bos; Ger T Rijkers Journal: Clin Vaccine Immunol Date: 2012-08-01
Authors: Karim Asehnoune; Charlene Le Moal; Gilles Lebuffe; Marguerite Le Penndu; Nolwen Chatel Josse; Matthieu Boisson; Thomas Lescot; Marion Faucher; Samir Jaber; Thomas Godet; Marc Leone; Cyrus Motamed; Jean Stephane David; Raphael Cinotti; Younes El Amine; Darius Liutkus; Matthias Garot; Antoine Marc; Anne Le Corre; Alexandre Thomasseau; Alexandra Jobert; Laurent Flet; Fanny Feuillet; Morgane Pere; Emmanuel Futier; Antoine Roquilly Journal: BMJ Date: 2021-06-02